Celiac Disease and Celiac Crisis

Celiac disease is an immune-mediated enteropathy triggered by gluten proteins in wheat, barley, and rye. In a genetically susceptible person—most often one carrying HLA-DQ2 or HLA-DQ8—gluten exposure activates inflammation in the proximal small intestine. The villi become shortened or flattened, reducing absorptive surface area; damage to the brush border also impairs digestion of some nutrients. The result is malabsorption rather than simply “an intolerance.” Iron deficiency may appear before obvious gastrointestinal symptoms. Folate, vitamin B12, calcium, vitamin D, and other nutrients may also become deficient. Reduced calcium and vitamin D absorption contributes to osteopenia or osteoporosis. Presentation varies. Chronic loose stools or steatorrhea, abdominal bloating, weight loss, fatigue, iron-deficiency anaemia, recurrent aphthous ulcers, or an itchy blistering rash consistent with dermatitis herpetiformis may all be clues. Some patients present mainly with anaemia, infertility, neuropathy, or low bone density. A normal body weight does not exclude celiac disease. The immune trigger is gluten, not an acute IgE-mediated food allergy. Wheat allergy more typically causes rapid urticaria, wheezing, vomiting, or anaphylaxis after exposure. Non-celiac gluten sensitivity can cause symptoms without the characteristic...